Senate Committee on Health and Human Services (02/11/2009)

Final
STAFF SUMMARY OF MEETING

SENATE COMMITTEE ON HEALTH AND HUMAN SERVICES

Date:	02/11/2009	ATTENDANCE

Time:	09:59 AM to 12:59 PM	Carroll M.	X
		Lundberg	X
Place:	SCR 354	Mitchell	X
		Morse	X
This Meeting was called to order by		Newell	X
	Senator Boyd	Schultheis	X
		Tochtrop	X
This Report was prepared by		Boyd	X
	Elizabeth Burger
		X = Present, E = Excused, A = Absent, * = Present after roll call

Bills Addressed:		Action Taken:
SB09-061 SB09-120 SB09-128 SB09-138 SB09-169		Amended, Referred to the Committee of the Whole Postponed Indefinitely Amended, Referred to Appropriations Amended, Referred to Appropriations Amended, Referred to the Committee of the Whole

10:00 AM -- Senate Bill 09-061

Senator Carroll introduced Senate Bill 09-061. Witness testimony on the bill occurred on Wednesday, February 4, 2009. She distributed amendment L.009 (Attachment A) and explained its provisions. The amendment specifies that a Colorado-licensed health care professional who lacks the appropriate expertise may perform utilization review related to an insurance claim, as long as he or she confers with a Colorado-licensed health care professional who has the appropriate expertise. If a Colorado-licensed health care professional is not available, the utilization review organization may use a health care professional who is licensed in good standing in another state and has appropriate expertise as long as the health care professional agrees to be subject to the jurisdiction and disciplinary authority of the appropriate Colorado licensing board. She responded to questions from Senator Newell regarding how one could know if the consultations required by the amendment are occurring. Senator Carroll noted that there would be regulatory consequences if it was discovered that they were not occurring. She stated that the amendment provides a number of different ways in which insurance companies can comply with the provisions of the bill. Senator Carroll responded to questions from Senator Schultheis regarding whether or not a revised fiscal note based on the amendment is available, noting that the bill gives more options for compliance to insurance companies, and those changes could only reduce the cost of the bill. She responded to additional questions from Senator Schultheis regarding how often claims are denied by personnel without appropriate expertise.


BILL:	SB09-061
TIME:	10:15:34 AM
MOVED:	Carroll M.
MOTION:	Adopt prepared amendment L.009 (Attachment A). The motion passed without objection.
SECONDED:
		VOTE
	Carroll M.
	Lundberg
	Mitchell
	Morse
	Newell
	Schultheis
	Tochtrop
	Boyd

Not Final YES: 0 NO: 0 EXC: 0 ABS: 0 FINAL ACTION: Pass Without Objection

10:15 AM

Senator Mitchell discussed the bill and explained his vote. Senator Carroll responded to Senator Mitchell's comments. Senator Lundberg stated his belief that the bill will make insurance more expensive. Senator Schultheis stated his concerns that the bill will increase regulation of insurance companies.


BILL:	SB09-061
TIME:	10:15:46 AM
MOVED:	Carroll M.
MOTION:	Refer Senate Bill 09-061, as amended to the Committee of the Whole. The motion passed on a 5-3 roll call vote.
SECONDED:
		VOTE
	Carroll M.	Yes
	Lundberg	No
	Mitchell	No
	Morse	Yes
	Newell	Yes
	Schultheis	No
	Tochtrop	Yes
	Boyd	Yes

Final YES: 5 NO: 3 EXC: 0 ABS: 0 FINAL ACTION: PASS

10:23 AM -- Senate Bill 09-120

Senator Mitchell introduced Senate Bill 09-120. The bill concerns the Sunset Review of the licensing program for psychiatric technicians. The bill continues the licensing of psychiatric technicians for five years, at which time, the regulation of psychiatric technicians will be repealed. Senator Boyd distributed a copy of amendment L.002 (Attachment B). Senator Boyd explained that the amendment would extend the repeal date of the licensing program for an additional year.

10:28 AM -- John Ramos, representing private psychiatric technicians, testified that private mental health care will be affected by ending the licensing program for psychiatric technicians. He stated that licensed psychiatric technicians (LPTs) are a vital resource for private mental health care programs, especially those the treat Alzheimer's patients and returning military personnel with post traumatic stress disorder. He testified that certified nurse aides (CNAs) have not had enough training to adequately perform the duties of a LPT.

10:34 AM -- Bill Ortiz, psychiatric technician and President of the Colorado Psychiatric Technicians Association, testified that psychiatric technicians have been licensed since 1967, and that the goal of licensing the profession is to ensure a qualified pool of personnel to care for patients in the state mental health facilities. He stated that Colorado has high standards for training people who care for patients with mental health needs, and they shouldn't be lowered. He stated that the mental heath facility in Pueblo will face workforce shortages in coming years, and he believes the bill will not help the situation. He spoke in favor of amendment L.002 (Attachment B).

10:38 AM -- Glenna Nickens, Colorado WINS, stated that there is already a shortage of nurses and that the bill threatens to overwhelm overworked nurses. She stated that LPTs care for a vulnerable population and patients rely on LPTs. She distributed a handout to the committee (Attachment C).

10:41 AM -- Judy Weaver, Colorado Mental Health Institute at Pueblo Community Advisory Board, relayed a number of statistics regarding the prevalence of mental illness in Colorado and nationally. She described the differences in the educational requirements for LPTs and CNAs. She stated that there are very few CNAs with medication authority in Colorado, and that CNAs are ill prepared to serve patients with complex medication needs. She asked the committee to oppose the bill. She responded to questions from Senator Newell regarding a federal court order related to forensic patients.

10:49 AM -- Bruce Harrelson, Department of Regulatory Agencies, responded to questions from Senator Carroll regarding the portion of the bill that removes a prohibition against a registered nurse delegating to another person the authority to select medications if the person is not authorized by law to select medications. He responded to an additional question from Senator Boyd regarding what would happen to the licensure of psychiatric technicians if Senate Bill 09-120 does not pass. Mr. Harrelson stated that the program is set to repeal July 1, 2010, but that the program could be extended during the 2010 session. He testified that he did not believe the bill would negatively impact psychiatric technicians.

10:54 AM -- Charlie Hebeler, Colorado Nurses Association, explained that the portion of the bill that concerns the delegation of medication administration authority affects professions other than LPTs. She explained medication protocols, and gave an example of how the protocols are used in medical facilities. He asked that the portion of the bill that removes the prohibition against delegation to select medications be removed from the bill. Senator Carroll commented, stating that particular provision does not seem to relate to the sunset of the licensure of psychiatric technicians, and that it would be better addressed as part of the sunset review of the State Board of Nursing. Ms. Hebeler responded to comments from Senator Mitchell regarding the effect of the language, stating that some parties believe that nurses may be pressured to delegate the medication administration duties when they don't feel comfortable doing so unless the prohibition remains intact.

11:02 AM

Senator Mitchell gave concluding remarks regarding the bill. He stated his belief that the bill will not reduce the supply of psychiatric technicians.


BILL:	SB09-120
TIME:	11:06:29 AM
MOVED:	Mitchell
MOTION:	Refer Senate Bill 09-120 to the Committee of the Whole. The motion failed on 3-5 roll call vote.
SECONDED:
		VOTE
	Carroll M.	No
	Lundberg	Yes
	Mitchell	Yes
	Morse	No
	Newell	No
	Schultheis	Yes
	Tochtrop	No
	Boyd	No

Not Final YES: 3 NO: 5 EXC: 0 ABS: 0 FINAL ACTION: FAIL


BILL:	SB09-120
TIME:	11:07:04 AM
MOVED:	Tochtrop
MOTION:	Reverse the previous roll call vote and postpone indefinitely Senate Bill 09-120. The motion passed without objection.
SECONDED:
		VOTE
	Carroll M.	Yes
	Lundberg	No
	Mitchell	No
	Morse	Yes
	Newell	Yes
	Schultheis	No
	Tochtrop	Yes
	Boyd	Yes

Final YES: 5 NO: 3 EXC: 0 ABS: 0 FINAL ACTION: Pass Without Objection

11:08 AM -- Senate Bill 09-128

Senator Carroll explained Senate Bill 09-128, which implements the recommendations of the Department of Regulatory Agencies in its sunset review of the administration of medications by unlicensed persons. Specifically, the bill continues the qualified medication administration person (QMAP) program, removes the QMAP education and evaluation program from the sunset review calendar, requires employers to document that all QMAPS in their employ have passed a competency evaluation at least once every 5 years, and requires employers who utilize QMAP services to conduct drug-related criminal background checks on potential employees.

11:10 AM -- Bryan Jameson, Department of Regulatory Agencies, stated that DORA failed to include in the sunset report a recommendation to strike current statutory language that requires the Department of Human Services and the Department of Corrections to maintain a list of the individuals who have successfully passed the QMAP competency exam and to forward the list to the Department of Public Health and Environment. He stated that there is no statutory requirement that the Department of Public Health and Environment maintain the list, and it is unclear how the list would be used if it were required to be maintained. He stated the list currently does not exist. Senator Carroll testified that she was not inclined to remove the requirement that the names be forwarded to the Department of Public Health and Environment, stated that transparency may be lost if the information is not publically accessible. Mr. Jameson reiterated that the QMAP program is not a regulatory program, but rather an educational program. Senator Tochtrop commented that the onus is on the employer to ensure that a QMAP has passed the qualifying exam, and that there is transparency for the consumer, stating that facilities will not employ persons without proof of their competency. Senator Tochtrop and Senator Carroll dialogued on whether or not the Department of Public Health and Environment should receive reports related to the competency evaluations for QMAPs. The committee further discussed the issue.

11:30 AM

Senator Boyd asked that the committee be permitted to review the amendment recommended by DORA. Kristen Forrestal, Office of Legislative Legal Services, came to the table to explain that an amendment had not been prepared in advance of the committee meeting, and explained the portion of current statute which DORA was seeking to be struck. Senator Carroll stated her belief that removing the requirement would weaken public oversight. Mr. Jameson further discussed the reasons why the department was seeking the amendment. Senator Boyd asked what the original purpose of the language requiring that the list be forwarded to the Department of Public Health and Environment was, and Mr. Jameson responded that he did not know.

11:35 AM -- Vennita Jenkins, Colorado Association of Homes and Services for the Aging, testified in support of the bill. Senator Carroll distributed amendment L.001 (Attachment D), which would specify that QMAPS have to take a competency evaluation at least once every five years, but not each time they are employed in a different facility. Ms. Jenkins responded to comments from Senator Tochtrop regarding the competency evaluation, stating that the exam lasts two days and is not readily available in Colorado.

11:43 AM -- Bryan Jameson, Department of Regulatory Agencies, returned to the table to respond to questions from Senator Schultheis regarding whether current statutory requirements requiring the departments to forward information about individuals who have passed the QMAP exam to the Department of Public Health and Environment should be retained. Mr. Jameson commented on the competency examination, stating that the test does not last two days and that passage of the exam should be required each time a QMAP is employed at a different facility. Senator Carroll responded to questions from Senator Morse regarding the competency evaluation and the maintenance of the list of QMAPs who have passed the evaluation, stating that medication errors are common and that the requirement for maintenance of the list is not onerous.

11:49 AM

Senator Carroll gave concluding remarks regarding the bill.


BILL:	SB09-128
TIME:	11:49:57 AM
MOVED:	Carroll M.
MOTION:	Adopt prepared amendment L.001 (Attachment D). The motion passed without objection.
SECONDED:
		VOTE
	Carroll M.
	Lundberg
	Mitchell
	Morse
	Newell
	Schultheis
	Tochtrop
	Boyd

Not Final YES: 0 NO: 0 EXC: 0 ABS: 0 FINAL ACTION: Pass Without Objection

11:50 AM

Senator Schultheis moved an amendment to strike the current statutory requirement that certain employers report the employees that have passed the competency evaluations to the Department of Public Health and Environment. Senator Carroll stated that she would like to be removed as the sponsor of the bill if the amendment is adopted. Various other committee members commented on the amendment and the potential fiscal impact of requiring the Department of Public Health and Environment to maintain the list.


BILL:	SB09-128
TIME:	11:55:59 AM
MOVED:	Schultheis
MOTION:	Adopt a conceptual amendment to remove the statutory requirement that certain employers report the employees that have passed the competency evaluation to the Department of Public Health and Environment. The motion passed on a 5-3 roll call vote.
SECONDED:
		VOTE
	Carroll M.	No
	Lundberg	Yes
	Mitchell	Yes
	Morse	No
	Newell	No
	Schultheis	Yes
	Tochtrop	Yes
	Boyd	Yes

Not Final YES: 5 NO: 3 EXC: 0 ABS: 0 FINAL ACTION: PASS


BILL:	SB09-128
TIME:	11:56:14 AM
MOVED:	Carroll M.
MOTION:	Refer Senate Bill 09-128, as amended, to the Committee on Appropriations. The motion passed on a 6-2 roll call vote.
SECONDED:
		VOTE
	Carroll M.	No
	Lundberg	Yes
	Mitchell	Yes
	Morse	No
	Newell	Yes
	Schultheis	Yes
	Tochtrop	Yes
	Boyd	Yes

Final YES: 6 NO: 2 EXC: 0 ABS: 0 FINAL ACTION: PASS

11:57 AM -- Senate Bill 09-138

Senator Boyd introduced Senate Bill 09-138. The bill implements the recommendations of the DORA sunset review on the certification program for nurse aides. Specifically, the bill continues the regulation of CNAs through September 1, 2020, makes changes to the advisory committee overseeing CNAs, and authorizes the Board of Nursing to require CNA training programs to include up to 25 percent more hours than the minimum federal requirements. She explained that the bill's fiscal note is related to the bill's provision that members of the advisory committee be permitted to receive a per diem. Senator Schultheis distributed amendment L.001 (Attachment E), which specifies that the advisory committee members not be permitted to receive a per diem.

12:01 PM -- Sheryle Hutter, Colorado Cross Disability Coalition, testified in opposition to the bill. She explained that the bill changes the composition of the advisory committee to remove a consumer's seat in favor of a seat for a member of the general public. She stated that if the bill is amended, the coalition would support the bill.

12:03 PM -- William Whatley, Front Range Nurse Aide Training Program, testified regarding the portion of the bill that permits the Board of Nursing to increase the number of training hours for CNA programs. He stated that there is no purpose or need specified in the sunset report for why an increase is being proposed and the increase in hours will increase costs and bureaucracy. He stated that the increase in hours should be accompanied by adequate standards and criteria regarding what the results of the training should be He stated that the increase in required hours will increase his operating costs, and that those costs will be passed along to those who are going through the training program. He stated that individuals entering CNA training programs can barely afford the program at its current cost. He testified regarding the importance of CNAs. He stated that his program was not contacted during the sunset review. Senator Boyd responded to questions from Senator Mitchell regarding why the bill is increasing the number of training hours required for CNAs, and committee discussion ensued. Senator Boyd responded that employers often pay for CNAs to attend the training programs. Mr. Whatley stated that CNAs are reimbursed for the costs of the training program, but they often are required to pay for the training up front. Senator Mitchell stated that instead of simply requirement more training hours, CNA training should be more narrowly focused on training deficiencies cited by long-term care facilities.

12:20 PM -- Bruce Harrelson, Department of Regulatory Agencies, came to the table to respond to questions raised by a previous witness regarding the membership of the advisory board, noting that consumers who wish to be on the board will still have an opportunity to be on the board. Senator Carroll asked why the bill removes current statutory language related to the delegation of medication authority, and Mr. Harrelson responded that he believed the removal of the language was standard for several sunset reviews. He responded to questions from Senator Schultheis regarding the bill's provision that provides for a per diem payment for members of the advisory committee.

12:24 PM -- Mark Merrill, Department of Regulatory Agencies, discussed the bill's changes to the membership of the advisory committee, noting that there have been problems in the past with filling the membership slots on the advisory committee, and the bill allows for additional flexibility.

12:26 PM

Senator Schultheis explained amendment L.001 (Attachment E). The amendment removes the requirement that members of the advisory board be paid a per diem.


BILL:	SB09-138
TIME:	12:26:05 PM
MOVED:	Schultheis
MOTION:	Adopt prepared amendment L.001 (Attachment E). The motion failed on a 3-5 roll call vote.
SECONDED:
		VOTE
	Carroll M.	No
	Lundberg	Yes
	Mitchell	Yes
	Morse	No
	Newell	No
	Schultheis	Yes
	Tochtrop	No
	Boyd	No

Not Final YES: 3 NO: 5 EXC: 0 ABS: 0 FINAL ACTION: FAIL

12:28 PM

Senator Carroll moved an amendment to strike section 14 of the bill. This section concerns the delegation of authority to select medications by a registered nurse.


BILL:	SB09-138
TIME:	12:28:23 PM
MOVED:	Carroll M.
MOTION:	Page 13, strike lines 13 through 21. The motion passed on a 7-1 roll call vote.
SECONDED:
		VOTE
	Carroll M.	Yes
	Lundberg	Yes
	Mitchell	Yes
	Morse	Yes
	Newell	Yes
	Schultheis	No
	Tochtrop	Yes
	Boyd	Yes

Not Final YES: 7 NO: 1 EXC: 0 ABS: 0 FINAL ACTION: PASS

12:30 PM

Senator Mitchell discussed the bill's requirements related to increased education training for CNAs. He moved an amendment to remove that section from the bill. The committee discussed Senator Mitchell's proposed amendment.


BILL:	SB09-138
TIME:	12:30:01 PM
MOVED:	Mitchell
MOTION:	Page 12, strike lines 8 through 17. The motion failed a 4-4 roll call vote.
SECONDED:
		VOTE
	Carroll M.	No
	Lundberg	Yes
	Mitchell	Yes
	Morse	No
	Newell	No
	Schultheis	Yes
	Tochtrop	Yes
	Boyd	No

Not Final YES: 4 NO: 4 EXC: 0 ABS: 0 FINAL ACTION: TIE


BILL:	SB09-138
TIME:	12:33:24 PM
MOVED:	Boyd
MOTION:	Refer Senate Bill 09-138, as amended, to the Committee on Appropriations. The motion passed on a 7-1 roll call vote.
SECONDED:
		VOTE
	Carroll M.	Yes
	Lundberg	Yes
	Mitchell	Yes
	Morse	Yes
	Newell	Yes
	Schultheis	No
	Tochtrop	Yes
	Boyd	Yes

Final YES: 7 NO: 1 EXC: 0 ABS: 0 FINAL ACTION: PASS

12:34 PM -- Senate Bill 09-169

Sen Tochtrop introduced Senate Bill 09-169. The bill implements the recommendations of DORA's sunset review on the licensing program for nursing home administrators. Specifically, the bill continues the Board of Examiners of Nursing Home Administrators through July 1, 2018. In addition, the bill allows the board to impose fines when a licensee or temporary license holder commits an act constituting grounds for discipline. Senator Tochtrop distributed amendment L.001 (Attachment F).

12:35 PM -- Arlene Miles, Colorado Health Care Association, testified that it is a federal requirement that nursing home administrators be licensed. She spoke in opposition to the portion of the bill that allows fines to be assessed against nursing home administrators. She stated that if there is action taken by the board against the administrator, the administrator does not have much of an opportunity to defend himself or herself. She testified that there are significant safeguards in place for the public, and that there already are a number of "hammers" to address issues of compliance. She asked that the fining authority be stricken from the bill. She responded to questions from Senator Lundberg regarding whether a gap exists in the range of penalties that can be assessed against a nursing home administrators. Ms. Miles noted that the facility can already be fined by the State Board of Health. Senator Carroll commented on the due process provided to nursing home administrators before a fine is assessed. Ms. Miles responded to Senator Carroll's comments, stating that the state should do more to positively support nursing home administrators.

12:51 PM -- Susan Miller, Department of Regulatory Agencies, testified in support of the bill. She responded to Ms. Miles' comments, stating that when complaints are filed, the individuals receive notice of the complaint and have a right to a hearing before an administrative law judge. She stated that nursing home administrators are not treated differently than any other professions regulated by DORA, and that other professions are subject to fines for violations. She described the rule making process that would be used to create the rules relating to the use of fines. She stated that the issue is one of personal responsibility for the nursing home administrator, and that assessment of fines is appropriate if the nursing home administrators don't live up to the standards of the profession.

12:56 PM

Senator Tochtrop gave concluding remarks regarding the bill. She explained that amendment L.001 (Attachment F) removes authority of the board to assess fines.


BILL:	SB09-169
TIME:	12:56:59 PM
MOVED:	Tochtrop
MOTION:	Adopt prepared amendment L.001 (Attachment F). The motion passed on a 5-3 roll call vote.
SECONDED:
		VOTE
	Carroll M.	No
	Lundberg	Yes
	Mitchell	Yes
	Morse	No
	Newell	No
	Schultheis	Yes
	Tochtrop	Yes
	Boyd	Yes

Not Final YES: 5 NO: 3 EXC: 0 ABS: 0 FINAL ACTION: PASS


BILL:	SB09-169
TIME:	12:58:02 PM
MOVED:	Tochtrop
MOTION:	Refer Senate Bill 09-169, as amended, to the Committee of the Whole. The motion passed on an 8-0 roll call vote.
SECONDED:
		VOTE
	Carroll M.	Yes
	Lundberg	Yes
	Mitchell	Yes
	Morse	Yes
	Newell	Yes
	Schultheis	Yes
	Tochtrop	Yes
	Boyd	Yes

Final YES: 8 NO: 0 EXC: 0 ABS: 0 FINAL ACTION: PASS

12:58 PM

The committee recessed.